WITCHDOCTOR ALERT: Diabetic Ketoacidosis (DKA) Myths

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Myth #1: We should get ABGs instead of VBGs in DKA…Busted: VBG can be used in place of ABGs

Myth #2: After Intravenous Fluids (IVF), Insulin is the Next Step…Busted: After starting IVF, the next step in DKA management is electrolyte replacement, NOT Insulin.

Myth #3: Once pH <7.1, Patients Need Bicarbonate Therapy…Busted: Intravenous bicarbonate therapy may transiently make acidemia better, but there is no improvement of glycemic control, time on insulin, time to hospital discharge, and in kids can worsen cerebral oedema.

Myth #4: We Should Bolus Insulin Before Starting the Infusion…Busted: Insulin boluses increase hypoglycemic events without other clinical benefits in the treatment of DKA.

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